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    pageEncoding="UTF-8"%>
<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<head>
    <title>更改挂号--理博软件2016</title>
    <meta charset="UTF-8">
    <link rel="stylesheet" type="text/css" href="statics/Css/bootstrap.css" />
    <link rel="stylesheet" type="text/css" href="statics/Css/bootstrap-responsive.css" />
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    <script type="text/javascript" src="statics/Js/ckeditor/ckeditor.js"></script>
 

    <style type="text/css">
        body {
            padding-bottom: 40px;
        }
        .sidebar-nav {
            padding: 9px 0;
        }

        @media (max-width: 980px) {
            /* Enable use of floated navbar text */
            .navbar-text.pull-right {
                float: none;
                padding-left: 5px;
                padding-right: 5px;
            }
        }


    </style>
    <script type="text/javascript">
    $(function () {       
		$('#backid').click(function(){
				window.location.href="exitadd.do";
		 });
    });
    </script>
</head>
<body>
<form action="resadd.do" method="post" class="definewidth m20">
<table class="table table-bordered table-hover definewidth m10">
    <tr>
        <td width="10%" class="tableleft">姓名</td>
        <td><input type="text" name="hosrName" value=""/></td>
    </tr>

    <tr>
        <td width="10%" class="tableleft">身份证号</td>
        <td><input type="text" name="hosrIdcar" value=""/></td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">社保号</td>
        <td><input type="text" name="hosrMedical" value=""/></td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">挂号费</td>
        <td><input type="text" name="hosrRegprice" value=""/>元</td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">联系电话</td>
        <td><input type="text" name="hosrPhone" value=""/></td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">是否自费</td>
        <td><input type="radio" name="hosrSelfprice" value="1" checked/>否&nbsp;&nbsp;&nbsp;
        <input type="radio" name="hosrSelfprice" value="0"/>是</td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">性别</td>
        <td><input type="radio" name="hosrSex" value="0" checked/>男&nbsp;&nbsp;&nbsp;
        <input type="radio" name="hosrSex" value="1"/>女</td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">年龄</td>
        <td><input type="text" name="hosrAge" value=""/></td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">职业</td>
        <td><input type="text" name="hosrWork" value=""/></td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">初复诊</td>
        <td><input type="radio" name="hosrLookdoctor" value="0" checked/>初诊&nbsp;&nbsp;&nbsp;
        <input type="radio" name="hosrLookdoctor" value="1"/>复诊</td>
    </tr>
    <tr>
        <td width="10%" class="tableleft">所挂科室</td>
        <td><select id="pId" name="pId">
        </select></td>
    </tr>
    <tr>
        <td width="10%" class="tableleft" >指定医生</td>
        <td><select name="dId" id="dId">
        	<option>--请选择--</option>
        </select></td>
    </tr>
	<tr>
        <td width="10%" class="tableleft">备注</td>
        <td><textarea name="hosrRemark"></textarea></td>
	</tr>
    <tr>
        <td colspan="2">
			<center>
				<button type="submit" class="btn btn-primary" type="button">保存</button> &nbsp;&nbsp;
				<button type="button" class="btn btn-success" name="backid" id="backid">返回列表</button>
			</center>
		</td>
    </tr>
</table>
</form>

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</body>
</html>